急性无骨折脱位型颈髓损伤的MRI表现与治疗

MRI Show and Treatment of Acute Cervical Spinal Cord Injuries without Fracture and Dislocation

18例无骨折脱位型颈髓损伤伤后1周内行MRI检查,表现为颈髓受损区T_2加权高信号T_1加权等或略低信号、椎间盘突出硬膜外血肿压迫脊髓等。11例手术采用前路减压并植骨,或后路单开门减压或椎管成形术同时药物治疗;7例保守治疗以牵引及药物治疗为主。经3个月随访,运动及感觉ASIA评分分别由34.5±17.2及48.4±11.7分增加至53.1±10.9及69.5±11.6分,差异十分显著(P<0.01)。认为其受伤机制为外伤性椎间盘突出、黄韧带皱折或硬膜外血肿压迫脊髓,或者一过性损伤,而原有退行性改变或椎管狭窄是发病的重要基础;MRI中T_2高信号范围大小是估计预后的简便方法;脊髓受压、椎管狭窄和椎间失稳是手术的指征。

Eighteen patients with non-fracture-dislocation cervical spinal cord injuries were checked by MRI within a week after trauma. It were seen that hyperointensity on T2WI and isomtensity or hypomtensity on T1 WI at area of servical spinal cord injury, compression on spinal cord of protrusive disc or epidural hematoma, et al. Eleven cases were performed anterior decompression and bone graft or hemilammectomy in case of spinal cord compressure or cervical stenosis. Seven cases were therapied by traction and drug. By three months followed up. their motion and sensition ASIA scores were im-proved from 34.5±17.2 and 48.4±11.7 to 53.1±10.9 and 69.5±11.6 respectively. The anterior and posterior treat-ment showed significant different (P<0.01). The authors think that the mechanism of the injuries is compression on spinal cord by protrusive disc, crease of yellow ligament, epidural hematoma or transicent injuries basing on the original degeneration and cervical stenosis. The size of hyperointensity on T2WI is a easy way to evaluate prognosis. Early opera-tion should be carried out in case of spinal cord compressure or cervical stenosis, instability of intravertebrae.